Provider Demographics
NPI:1477586865
Name:SORIANO, SOFRONIO SAGUCIO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SOFRONIO
Middle Name:SAGUCIO
Last Name:SORIANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30844
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89173-0844
Mailing Address - Country:US
Mailing Address - Phone:702-750-2837
Mailing Address - Fax:702-750-2847
Practice Address - Street 1:2610 S JONES BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5635
Practice Address - Country:US
Practice Address - Phone:702-750-2837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10082208D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018538Medicaid
NV1922273101Medicaid
NV1922273101Medicaid
NVV105992Medicare PIN
NV002018538Medicaid